The role of radiosurgery and particulate embolization in the treatment of dural arteriovenous fistulas

Michael J. Link, Robert J. Coffey, Douglas A. Nichols, Deborah A. Gorman

Research output: Contribution to journalArticle

106 Scopus citations

Abstract

Over the past 5 years 29 patients with dural arteriovenous fistulas (AVFs) were treated by the authors using the Leksell radiosurgical gamma knife unit. Within 2 days after radiosurgery, 17 patients with AVFs that exhibited retrograde pial or cortical venous drainage (12 patients) and/or produced intractable bruit (eight patients) underwent particulate embolization of external carotid feeding vessels. The rationale for this treatment strategy was that radiosurgery was expected to cause obliteration of most fistulas after 12 to 36 months. In patients with bruit, ocular symptoms, or in those at risk for hemorrhage, treatment with embolization after radiosurgery kept the fistulas angiographically visible for radiosurgical targeting yet offered palliation of symptoms and temporary, partial protection from hemorrhage during the latency period. In 12 patients, preobliteration embolization immediately reduced (10 patients) or eliminated (two patients) retrograde pial venous drainage. To date, no lesion has hemorrhaged after treatment. Angiography 1 to 3 years posttreatment in 18 patients showed total obliteration of 13 fistulas (72%) and partial obliteration of five (28%). Radiosurgery, followed by embolization when retrograde pial venous drainage, intractable bruit, and/or major external carotid artery supply is present, appears to be a promising treatment for selected patients with symptomatic dural AVFs.

Original languageEnglish (US)
Pages (from-to)804-809
Number of pages6
JournalJournal of neurosurgery
Volume84
Issue number5
DOIs
StatePublished - May 1996

Keywords

  • arteriovenous malformation
  • dural arteriovenous fistula
  • gamma knife
  • radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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